tbuckley/cabot-search huggingface dataset:
Abstract 14239: Development and Validation of a Daily Measure of Cardiorespiratory Fitness - Estimated Vo <sub>2</sub> Max - Using Multiparametric Data From a Wearable Sensor
Authors: Dylan M Richards, Maged Gendy, Karen A Larimer, Steven R Steinhubl, Matthew Pipke
Journal: Circulation (2022)

Introduction: The objective determination of a person’s cardiorespiratory fitness over time, especially in those with heart failure, can play a critical role in optimizing individual therapies, identifying early signs of decompensation, and accelerate the development of novel therapeutic interventions. However, existing methods, such as formal cardiopulmonary exercise testing (CPET), or surrogates like a 6-minute walk test (6MWT) are difficult for both patients and health systems and provide only sparse samples. Hypothesis: Using a wearable ECG-patch sensor and machine learning methods, cardiorespiratory fitness can be estimated daily using routine vital sign dynamics during free-living activities. Methods: CPETs and multiple days of ECG-patch sensor data were collected within 2 weeks of each other for 228 participants (146 normal, and 82 with Heart Failure). A model for VO 2 max estimation was developed using a two-stage procedure. (Figure) In the first stage, the model was pretrained on an unsupervised regression task on over 2000 unique patients’ data, representing over 200 patient-years of activity of daily living. The second stage fine-tuned the pretrained model to predict VO 2 max, using a K-Fold cross validation procedure with 50% train, 25% validation, and 25% testing for four folds. Results: CPET-determined VO 2 max values ranged from 7.1 to 69.1 ml/kg/min (median=28.9, IQR=24.5). The Pearson Correlation Coefficient (PCC) and Mean Absolute Error (MAE) of the estimated VO 2 max was 0.85 and 6.2 ml/kg/min, respectively. For the heart failure subgroup, the PCC and MAE are 0.73 and 3.7 ml/kg/min, respectively. (Figure) Conclusion: Our results show that estimated VO 2 max can be accurately and conveniently determined at high frequency in individuals with a wide range of cardiorespiratory fitness using data from a patch sensor during routine daily activities. Ongoing work in a large HF trial will evaluate its performance over time relative to 6MWT and surveys.
Abstract 13987: Cost-Effectiveness of Direct Oral Anticoagulant vs Warfarin Among Atrial Fibrillation Patients With Intermediate Stroke Risk
Authors: Jin-Bae Kim, Woo-Shik Kim, Young-Shin Lee
Journal: Circulation (2022)

Background: Several studies have shown the cost-effectiveness of direct oral anticoagulants (DOACs), compared with warfarin, to prevent atrial fibrillation (AF) related complications. However, few have reported cost-effectiveness of DOACs in AF patients with intermediate stroke risk. Thus, we investigated the cost-effectiveness of DOACs vs. warfarin in non-valvular AF patients with intermediate stroke risk using national representative data. Methods: We identified 7,954 newly diagnosed non-valvular AF patients (≥18 years) with intermediate stroke risk (CHA2DS2-VASc score: 1 for men and 2 for women) using the national healthcare utilization data from August 1, 2016, to July 31, 2019. Annual incidence rate of AF-related composite outcomes (heat failure, myocardial infarction, ischemic stroke, intracerebral hemorrhage, and gastrointestinal bleeding) was estimated. Cost-effectiveness was estimated using a Markov chain model with the transition probability of 1 year. The willingness-to-pay (WTP) was set at $32,000 per quality-adjusted life-year (QALY) gained. Results: The total cost of warfarin, rivaroxaban, apixaban, dabigatran and edoxaban was $2,874, $5,761, $5,151, $5,761 and $5,851, respectively. The QALYs gained were 10.83, 10.95, 11.10, 10.49 and 10.99 years, respectively. The incremental cost-effectiveness ratio of rivaroxaban, apixaban, dabigatran and edoxaban was $29,743.99, $8,426.71, -$8,483.04 and $18,483.55, respectively. The WTP was set at $32,000. DOACs (except dabigatran) were more cost-effective compared with warfarin because they did not exceed the WTP in the base-case analysis. Conclusion: Our findings showed that DOACs were more cost-effective than warfarin in non-valvular AF patients with intermediate stroke risk. Figure 1. Cost-effectiveness acceptability curve of Warfarin vs. DOACs in AF patients with intermediate stroke risk.
Abstract 14285: Comparison of Percutaneous Coronary Intervention-Related Adverse Cardiac Outcomes in Patients With In-Stent versus De Novo Chronic Total Occlusion: A Systematic Review and Meta-Analysis
Authors: Anthony Lyonga Ngonge, Nso Nso, Yolanda Mbome, Ahmed Brgdar, Mpey Tabot Tabot, Basharat Ahmad, Mohamed TAHA, Prince Alebna, Muhammad Munawar, Nformbuh Asangmbeng, Valery Effoe, Prafulla P Mehrotra, FATIMA UROOJ
Journal: Circulation (2022)

Introduction: Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). Hypothesis: This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI. Methods: This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2,734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multi-centered studies published between January 2005 and December 2021. Results: We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89, p &lt;0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53, p &lt;0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10, p &lt;0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00, p = 0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables. Conclusions: The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.
Abstract 14400: Predicting In-Hospital Mortality Among Patients Admitted With Heart Failure: A Machine Learning Approach
Authors: Rosemary He, Zina Jawadi, Pratyaksh Srivastava, Suzan Khalil, Eleazar Eskin, Jeffrey Chiang, Ali Nsair
Journal: Circulation (2022)

Introduction: Patients hospitalized with heart failure (HF) experience high in-hospital mortality. Machine learning predictive models have the potential to identify heart failure patients at risk of adverse outcomes. Methods: Using the electronic medical record (EMR) at a large academic medical center, we identified 49,457 patients who were admitted with heart failure from 2011 to 2022. 71% were admitted with HF with reduced ejection fraction (HFrEF, EF≤40%) and 29% with HF with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF, EF &gt;40%). Using patient demographics, comorbidities, admission medications, labs, and vitals throughout the hospitalization, we constructed random forest machine learning models to predict in-hospital mortality. We compared model performance to that of logistic regression utilizing the same variables. Results: The median age (25th-75th percentile) of the cohort was 72 (59-83) years, and 45% of the group was female. 71% patients were admitted with HFrEF and 29% patients were admitted with HFmrEF/HFpEF. For the overall cohort, our machine learning model was able to predict in-hospital mortality with a sensitivity (SN) of 91%, a specificity (SP) of 85%, and an area under the curve (AUC) of 0.95 (Figure 1). For those with HFrEF, our model demonstrated a SN of 91%, SP of 87% and AUC of 0.95, and for those with HFmrEF/HFpEF, a SN of 87%, a SP of 89%, and an AUC of 0.94. For all three cohorts, our models outperformed logistic regression. The top predictors of in-hospital mortality were BNP, BUN, and Systolic BP for those admitted with HFrEF, and sex, creatinine, and diastolic BP for those with HFmrEF/HFpEF. Conclusions: Machine learning models built from EMR data have the ability to accurately predict in-hospital mortality among patients admitted for HF. Such prediction tools, when used in the appropriate context, may help flag hospitalized heart failure patients at high risk for in-hospital mortality.
Abstract 14248: The Impact of Trastuzumab on the Pulmonary Artery Systolic Pressure in Patients With HER-2 Positive Breast Cancer
Authors: Zaid A Abdulelah, Mohammad Z Khrais, Ruba A Ghalayni, Faris Al-Khalili, Mohammad Alqaisieh, Mu'taz F AbuAlSha'r, Ahmed A Abdulelah, Yazan S Abandeh, Dalia Al-Rimawi, Ismail R Hamam
Journal: Circulation (2022)

Introduction: Despite that trastuzumab (TZB) improves life expectancy and prognosis in patients with HER-2 positive breast cancer (BC), cardiotoxicity is a well-established complication. However, other potential cardiac complications of TZB such as pulmonary hypertension (PHTN) are poorly investigated. Aim: Evaluate the effect of TZB on pulmonary artery systolic pressure (PASP) and measure the predictors of developing elevated PASP. Methods: The medical records for all females who received TZB treatment for confirmed HER-2 positive BC at King Hussein Cancer Centre in Jordan between 2014 - 2019 who had a documented normal PASP of ≤35 mmHg before treatment were evaluated. Results: A total of 436 patients with a mean age of 53±11 years were included. The leading comorbidities were hypertension and diabetes mellitus affecting 26.2% and 15.4% of the patients, respectively. 15.6% of the study’s population were active smokers. Prior to initiating TZB, 22.3% had left ventricular hypertrophy (LVH), 14.3% had mild tricuspid valve regurgitation (TR), 11.5% had pericardial effusion, and 4.8% had mild aortic valve regurgitation (AR).Of alarming significance, 24.8% of the patients had their PASP increased after one year. Patients who developed elevated PASP tend to be older (56.9 vs 51.3, P&lt;0.001), had baseline mild TR (26.3% vs 10.3%, P&lt;0.001), LVH (39.4% vs 17.6%, P&lt;0.001), and mild AR (9.1% vs 3.7%, P=0.031).Multivariate analysis showed that the only predictors of elevated PASP are TR at baseline (OR 3.9; 95% CI 1.58-6.17, P=0.001), and age (OR 1.04; 95% CI 1.01-1.06, P=0.005). However, baseline LVH (OR 1.79; 95% CI 0.98-3.26, P=0.057), number of the TZB cycles (OR 0.93; 95% 0.85-1.02, P=0.152), and the total dose of TZB (OR 1; 95% CI 1-1, P=0.284) were non-significant predictors. At 1 year follow up, the mean total cumulative dose of TZB was 6.8±1.8 grams that were given at a mean of 15±3 cycles. Moreover, major events (heart failure exacerbation, pulmonary embolism, and acute coronary syndrome) were recorded in 3.9% of the patients and death occurred in 4.1%. Conclusions: Trastuzumab demonstrated an increase in the PASP in a considerable portion of the patients at 1-year interval with this elevation being substantially concerning due to being highly indicative of PHTN.
Abstract 13951: Sex Difference in Patients With Heart Failure: A Multicenter, Retrospective 8-year Observational Study
Authors: Chun-Chao Chen, Ju-Chi Liu, Min-Huei Hsu, Chun-Chih Chiu, Jiunn-Lee Lin
Journal: Circulation (2022)

Introduction: In real world, the difference of clinical characteristics and long-term outcomes between male and female patients (pts) with heart failure (HF) remained unclear. Methods: A total of 12,428 pts (6,518 men and 5,910 women) with first time HF hospitalization in Taipei Heart Institute HF cohort from 2011 to 2020 were analyzed. Baseline characteristics, echocardiogram, all-cause death, cardiovascular (CV) death and HF rehospitalization were assessed. Results: Female pts with HF hospitalization diagnosis were older than male (76.04 ± 13.43 vs. 71.20 ± 13.43 year-old respectively, p&lt;0.0001), with higher prevalence of hypertension, diabetes and thyroid disease (70.74% vs. 65.02%, p&lt;0.0001; 42.86% vs. 38.55%, p&lt;0.0001; 9.81% vs. 5.25%, p&lt;0.0001, respectively) but lower prevalence of ischemic heart disease, cerebrovascular disease and chronic obstructive lung disease compared with men (12.47% vs. 16.78%, p&lt;0.0001; 3.91% vs. 6.31%, p&lt;0.0001; 10.80% vs. 20.28%, p&lt;0.0001, respectively). Also, higher proportion of significant chronic kidney disease (eGFR &lt; 60 ml/min/1.73m 2 ) was noted among female pts (p&lt;0.0001). In echocardiography, more female pts had preserved left ventricular ejection fraction (LVEF) (LVEF &gt;50%, female: 63.84% and male: 51.60%, p&lt;0.0001), with greater LV mass index (female, 90.38 ± 35.03 vs. male, 84.67 ± 31.73 g/m 2 , p&lt;0.0001), smaller LV end diastolic diameter and left atrial size were noted (female vs. male, 46.47 ± 7.77 vs. 50.70 ± 8.57mm, p&lt;0.0001; 41.39 ± 8.00 vs. 42.34 ± 7.99mm, p&lt;0.0001). In addition, more usage of guideline-directed HF medications were noted in female pts (p&lt;0.0001). After multivariate adjustment, significantly lower risk of longterm all cause death and CV death were noted in female pts compared to male (adjust hazard ratio [aHR]: 0.89, 95% confidence interval [CI]: 0.85-0.94; aHR: 0.90, 95% CI: 0.74-0.88, respectively) over 8-year followup by Kaplan-Meir curve analysis. However, risk of HF rehospitalization was similar between female and male pts (aHR: 1.02, 95% CI: 0.95-1.09). Conclusions: Significant differences in clinical characteristics, echocardiographic findings, long-term CV mortality and all-cause mortality were observed between female and male pts with HF in the present cohort.
Abstract 14283: Influence of the HEAR Score for 30-day Risk-Stratification in Emergency Department Patients Evaluated With High-Sensitivity Cardiac Troponin T
Authors: Olatunde Ola, Ashok Akula, Laura De Michieli, Jonathan D Knott, Ramila A Mehta, David O Hodge, Rajiv Gulati, Allan S Jaffe, Yader Sandoval
Journal: Circulation (2022)

Background: The 2021 ACC/AHA chest pain guidelines recommend risk scores such as HEAR (History, Electrocardiogram, Age, Risk Factors) for short term risk-stratification yet limited data exists integrating them with high-sensitivity cardiac troponin T (hs-cTnT). Methods: Retrospective, multicenter (n=2), observational, U.S. cohort study of consecutive ED patients without ST-elevation myocardial infarction (MI) who had at least one hs-cTnT (limit of quantitation, LoQ, &lt;6 ng/L, and sex-specific 99 th percentiles of 10 ng/L for women and 15 ng/L for men) measurement on clinical indication in whom HEAR scores (0-8) were calculated. The composite major adverse cardiovascular (MACE) outcome was 30-day MI and death. Results: Among 1,979 ED patients undergoing hs-cTnT measurement, 1045 (53%) were classified as low-risk (0-3), 914 (46%) as intermediate-risk (4-6), and 20 (1%) as high-risk (7-8) based on HEAR scores. HEAR scores were not associated with an increased risk of 30-day MACE after adjusted analyses. Outcomes according to risk-strata based on HEAR scores and baseline hs-cTnT are shown in Table 1. Patients with quantifiable hs-cTnT (LoQ-99 th ) had an increased risk for 30-day MACE (3.4%) despite being estimated to be low-risk (0-3) per HEAR scores. Conversely, those with serial hs-cTnT&lt;99 th percentile remained at low-risk (range 0% to 1.2%) for 30-day MACE across HEAR score strata. Conclusions: HEAR scores are of limited value in those with baseline hs-cTnT&lt;LoQ or hs-cTnT&gt;99 th percentile where hs-cTnT identifies very low and high-risk patients irrespective of HEAR scores. In those with baseline quantifiable hs-cTnT within the reference range (&lt;99 th percentile), a higher risk (&gt;1%) for 30-day MACE exists even in those with low HEAR scores. With serial hs-cTnT measurements, HEAR scores overestimate risk when hs-cTnT remains &lt;99 th percentile.
Abstract 13674: Optimal Hounsfield Threshold for Lipid-Rich Plaque by Artificial Intelligence-Enabled Quantitative CT Using Near-Infrared Spectroscopy
Authors: Hiroyuki Omori, Hitoshi Matsuo, James Earls, Yoshihiro Sobue, Shinichiro Fujimoto, Yui Nozaki, Gaku Nakazawa, Kuniaki Takahashi, Kazuhiro Osawa, Ryo Okubo, Umihiko Kaneko, Hideyuki Sato, Takashi Kajiya, Toru Miyoshi, Keishi Ichikawa, Mitsunori Abe, Toshiro Kitagawa, Hiroki Ikenaga, Mike Saji, Nobuo Iguchi, Takeshi Ijichi, Hiroshi Mikamo, Akira Kurata, Masao Moroi, raisuke iijima, Tami Crabtree, James K Min, Rine Nakanishi
Journal: Circulation (2022)

Introduction: By near-infrared spectroscopy (NIRS), plaques with 4-mm maximum lipid-core burden index (maxLCBI4 mm ) ≥ 400 are lipid-rich plaque. By CCTA, the optimal Hounsfield threshold (HU) for lipid-rich plaques defined by presence of low-density non-calcified plaque (LD-NCP) is still unclear. Hypothesis: Artificial intelligence-enabled quantitative CT (AI-QCT) will enable identification of HU for lipid-rich plaques when compared to NIRS reference standard. Methods: 128 atherosclerotic plaques from 47 patients were enrolled prospectively. MaxLCBI 4mm (cutoff was defined as 400) and LD-NCP derived from AI-QCT (Cleerly LABS, Denver CO) were compared. LD-NCP using 3 different thresholds (&lt;30, &lt;50, and &lt;70 HU) were analyzed by sensitivity, specificity, positive and negative predictive value, accuracy, and area Under the Curve (AUC). Results: Amongst 128 atherosclerotic plaques evaluated, 26 (20.3%) met NIRS criteria for lipid rich plaque (maxLCBI 4mm ≥400). The volume of LD-NCP was measure using three different thresholds, &lt;30, &lt;50, and &lt;70 HU as well as criteria of PR &gt; 1.1 and LD-NCP volume &gt;1.8 mm 3 (LD-NCP volume threshold identified from AUC). This yielded a sensitivity, specificity, positive and negative predictive value, accuracy, and AUC of 92%, 88%, 67%, 98%, 89%, and 0.944 at &lt;30HU, 96%, 79%, 53%,99% 82%, 0.921 at &lt;50HU, and 96% 72%, 46%, 99%, 77%, and 0.907 respectively at &lt;70HU (30 vs. 50 HU: p=0.008; 30 vs. 70HU: p=0.002 (Figure 1). Conclusions: A &lt;30 HU threshold for definition of LD-NCP on AI-QCT correlates optimally with NIRS proven lipid-rich plaques.
Abstract 13815: SARS-CoV-2 and Plasmodium Falciparum Co-Infection A Lethal Combination to the Heart
Authors: Karina A Gonzalez Carta, Elirub Rojas, Carmen M Terzic, Ivan Mendoza, Ivan Mendoza
Journal: Circulation (2022)

Introduction: COVID-19 pandemic has had an unprecedented impact worldwide, co-infections with neglected tropical diseases like Malaria can occur and affect the heart. Objective: Describe a unique case of Malaria and SARS CoV2 infection occurring concurrently with cardiac complications. Clinical Case: A 69-year-old male, retired canoeing athlete, with well-controlled arterial hypertension, presented odynophagia, cough, and dyspnea on slight exertion for 2 days. On examination, O2 saturation was 91%, blood pressure 100/60 mmHg, regular heart rate of 110 bpm, positive PCR for SARS-CoV-2, elevated D-Dimer, and chest X-ray with evidence of viral pneumonia. He received supplemental oxygen, steroids, and paracetamol. Two days later, he presented with choluria, afternoon episodes of high fever preceded by chills and myalgia, and a thick blood smear showed Plasmodium falciparum (PF) trophozoites. Antimalarial treatment was started with primaquine 15mg, 20 mg of artemether, and 120 mg of Lumefantrine daily with the disappearance of fever until day 14 of onset of symptoms when he presented with acute heart failure (AHF) with a reduced ejection fraction of 45%. NYHA Class IV, arterial hypotension, sudden onset palpitations, and afternoon febrile episode. The electrocardiogram showed atrial fibrillation (AF) with a rapid irregular ventricular response of 120 bpm; The echocardiogram revealed a 7mm circumferential pericardial effusion, right ventricular dysfunction. Treatment with colchicine, enoxaparin, spironolactone, and bisoprolol was started. A new thick smear demonstrated the persistence of PF. A new antimalarial regimen was restarted, with the disappearance of the fever 48 hours after its onset, with the reversion of AF to sinus rhythm. Discussion: A unique case of concurrent COVID-19 and Malaria, which cause challenges to the heart and lead to cardiovascular complications. Conclusion: An exceptional case is presented, the coexistence of SARS-CoV-2 and PF infection-associated complications of myocarditis, pericarditis, new-onset AF, and AHF. This interaction should not go unnoticed, physicians’ awareness is key, and early diagnosis and treatment can be lifesaving, mitigate and offer the best chance of cure.
Abstract 14362: A Case of a Primary Malignant Pericardial Myxoid Sarcoma in a Young Adult
Authors: Apurv Agarwal, Viral K Desai, Marcus F Stoddard
Journal: Circulation (2022)

Introduction: Primary pericardial malignant tumors are rare clinical entities with an incidence of 0.001%. The symptoms depend on the location and size of the mass, typically causing chest pain, dyspnea, or syncope. We present the case of a young man with atypical chest pain, rapidly progressing to cardiac arrest from a primary pericardial myxoid chondrosarcoma. Case Presentation: A 31-year-old man presented with atypical chest pain. Subsequently, he had a cardiac arrest with pulseless electrical activity. CT chest revealed a 9.5 x 10 cm epicardial mass (Figure 1a, 1b) found to be a myxoid sarcoma on CT-guided biopsy. The morphology was suggestive of a high-grade extra-skeletal myxoid chondrosarcoma. Cardiac MRI had normal function and no myocardial invasion. The staging MRI did not show any other primary source. Due to the large size of the mass, a decision was made to perform surgical resection. Most of the tumor was excised but had positive margins from the part adherent to the inferior vena cava. In the absence of clear guidelines, multiple chemotherapy regimens including doxorubicin, ifosfamide, and etoposide were tried. The initial response was complicated by eventual recurrence and metastasis to the chest wall and mediastinum (Figure 1c, 1d). Further, genetic testing with next-generation sequencing demonstrated MAP3K1 gene mutation. As MAP3K1 mutations have shown sensitivity to MEK inhibition, targeted chemotherapy with trametinib was initiated in combination with pazopanib, a multikinase inhibitor. With the progression of metastatic disease despite treatment, the patient decided to pursue palliative care. Discussion: Malignant pericardial myxoid chondrosarcoma is a rare tumor that may lead to fatal outcomes in young adults. Despite numerous surgical and chemotherapeutic interventions, they have a guarded prognosis. Increased clinician awareness and a wide differential while evaluating cardiac masses are key for early detection and timely treatment.